Organising and evaluating diabetic care in general practice

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An audit of diabetic care provided to patients conducted by a doctor-nurse team in a general practice

Introduction: I am a general practitioner in solo practice in Athlone. I work closely with a qualified nursing sister. Many of the patients we attend to have non-insulin dependent diabetes mellitus. Aim: To implement change in the management of our patients with diabetes by developing a protocol for future improved care. Objective: To assess the quality of care provided to patients with (NIDDM), by a doctor - nurse team in private general practice. Method : The study was quantitative and qualitative and consisted of 3 sections : 1) an internal audit based on the retrospective examination of patients' medical records, 2) a questionnaire which was administered to determine patients' knowledge of their disease and 3) a focus group interview which centred around patients' experience of the disease and feelings about the service provided. The interview was audio taped. Findings: Problem areas identified were sub-optimal record keeping; poor attendance and infrequent eye and foot examinations; patients' knowledge of their disease was limited; certain aspects of doctor-patient and patient-family relationships that may impact negatively on care; fears and anxieties relating to the disease and perceptions oflocus of control as external

Understanding, Protecting, Promoting and Entrenching the Rule of Law – What Individuals, Constitutional Institutions, State Entities and Civil Society must do

The UWC Law Faculty in 2019 celebrated its 40 year existence as an independent faculty. The Law Faculty became an independent faculty on 1 January 1979 when the Faculty of Commerce and Law was divided in two: the Faculty of Economic and Management Sciences and the Faculty of Law. The Dean’s Distinguished Lecture was initiated in 2015, with the following judges as speakers: Moseneke (2015), Pillay (2016), Cameron (2017), and Ngoepe (2018). Justice Mahomed Navsa, who presented the lecture in 2019, obtained the BA (law) degree from UWC in 1978 and the LLB degree in 1980. In his lecture, Justice Navsa emphasised the importance of consolidating the gains of the struggle against apartheid through the establishment of the rule of law. In an age where the Constitution is under attack from many sides, Justice Navsa emphasised the importance of fulfilling the promises of that Constitution, not only by government and public officials, but by each citizen

Skeletal morphology of the human hand as applied in forensic anthropology

The lack of detailed descriptions makes positive identification of individual bones of the human hand difficult. In some instances, labelled photographs and line diagrams depicting a few anatomical features are available in the literature while in other cases, unlabelled photographs and diagrams are provided. Textbooks generally describe each hand bone as having a head, shaft and base. The morphology of metacarpals is more commonly described than that of the phalanges. Thus, identification and siding of hand bones are rare, which excludes them from use in many forensic cases. Forensic anthropological studies also include the determination of demographic characteristics such as stature and sex. Parts of the human skeleton that are accurate predictors in determining stature and sex include the skull, pelvis, femur and tibia. Hand bones are often excluded from such studies due to their relatively small size and poor preservation. The aims of this study were firstly, to provide detailed morphological descriptions of metacarpals and phalangeal bones of the human hand; secondly, to develop regression formulae for stature using the hand bones and thirdly, to develop discriminant function formulae in which the hand bones can be used to determine the sex of an unknown individual. The study comprised 200 sets of hands of South African individuals. The results indicate that there are morphological features of individual bones of the human hand that can be used to identify and side them. Regression formulae have been devised whereby the length of a hand bone can be regressed to that of a long bone, which in turn can then be used to determine stature. The sexing accuracy, using the bones of the hand, is high for males and females. Average accuracies recorded were more than 80% in most cases, and more than 75% in all cases. Analyses of human hand bones can thus add valuable information when assessing skeletons of unknown individuals.Thesis (PhD)--University of Pretoria, 2010.Anatomyunrestricte

The radial nerve danger zone : a cadaver study

Certain distal humerus fractures and elbow fracture dislocations warrant early fixation with an external fixator. The distal humerus is close to the radial nerve and a hazardous area for the placement of an external fixator. No known safe zone for the placement of an external fixator has been identified on the lateral border of the humerus. We record the incidence of radial nerve damage following external pin fixation and note the relation of the radial nerve to each pin. A total of 39 cadavers were dissected for this study. Two 4 mm pins were placed with a multi-pin clamp into the lateral border of the right and left humerus at 100 mm and 70 mm proximal to the lateral epicondyle. We dissected the upper limbs and recorded the incidence of radial nerve damage and the position of the nerve in relation to the two pins. Data for right and left sides were combined. The radial nerve was damaged by the proximal and distal pin in 56.4% and 20.5% respectively. The radial nerve was located anterior to the proximal pin (41%) and distal pin (79.5%). The radial nerve was located posterior to the proximal pin (2.6%) and distal pin (0.0%). We were unable to identify a safe zone from this study. We propose that pins should be placed less than 100 mm proximally from the lateral epicondyle and as posterior as possible to minimise the risk of radial nerve damage.https://www.saoa.org.za/publications/saojam2018AnatomyOrthopaedic Surger

Barriers to initiating insulin therapy in patients with type 2 diabetes mellitus in public-sector primary health care centres in Cape Town

Background: The majority of patients with type 2 diabetes mellitus in Cape Town who attend primary care community health centres (CHCs) have unsatisfactory glycaemic control. Insulin is rarely prescribed despite its being indicated for type 2 diabetic patients with inadequate metabolic control on maximum oral glucose-lowering agent (OGLA) therapy. Objective: The study examined barriers to initiating insulin therapy in poorly controlled type 2 diabetes patients on maximum OGLAs in CHCs in the Cape Town metropole. Methods: Five focus group discussions and 10 in-depth semistructured individual interviews were conducted with 46 medical officers working at the CHCs. The discussions and interviews were transcribed and common themes were identified and categorised. Results: Doctor, patient, and system barriers to initiating insulin therapy were identified. Doctors\' barriers include lack of knowledge, lack of experience with and use of guidelines related to insulin therapy, language barriers between doctor and patients, and fear of hypoglycaemia. Patient barriers were mistaken beliefs about insulin, non-compliance, lack of understanding of diabetes, use of traditional herbs, fear of injections, and poor socioeconomic conditions. System barriers were inadequate time, lack of continuity of care and financial constraints.Conclusion: Suggestions for overcoming barriers include further education of doctors on insulin initiation and the use of standardised guidelines. In addition, a patient-centred approach with better communication between doctors and patients, which may be achieved by reorganising aspects of the health system, may improve patient knowledge, address mistaken beliefs, improve compliance and help overcome barriers. Further research is needed to investigate these recommendations and assess patients\' and nurses\' perceptions on initiating insulin therapy. South African Medical Journal Vol. 95(10) 2005: 798-80

Azygos lobe in a South African cadaveric population

Knowledge of the prevalence, morphology and location of the azygos lobe is essential for diagnostic and surgical procedures of the lungs related to mediastinal pathologies, especially to minimize intraoperative vascular injuries, shock, possible thoracotomy and even the possibility of pulmonary torsion. Reports on the prevalence of the azygos lobe vary between 0.11% and 0.43%. The aim of the current study was to record the prevalence and morphological description of the azygos lobe in the South African cadaveric population. A total of 704 adult cadavers dissected over a ten-year period by students in the Department of Human Anatomy at the Medunsa Campus, University of Limpopo, were studied. The prevalence and dimensions of the azygos lobe were determined with a 95% confidence interval. Results indicate that an azygos lobe was present in the right lung in only four cases (prevalence 0.57%, 95% Confidence Interval [CI]: 0.2%-1.6%). The mean height and width were 6.7 cm (95% CI: 4.4-9.2) and 4.5 cm (95% CI: 3.7-5.2) respectively. Observations on the morphology of the azygos lobe showed that it was rectangular (n=3) and triangular (n=1) in shape with smooth margins. In conclusion, the azygos lobe is a rare anomaly in the South African cadaveric population. The present results are comparable with those reported in the literature for other populations. Future radiological studies on the azygos lobe on living subjects in South Africa will be useful for further understanding of this rare but significant anomaly.http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1098-2353hb2013ay201

Sexing accuracies using proximal and middle phalanges of the hand in a modern south african sample

Forensic anthropologists include sex determination as part of their analyses. Hand bones were previously excluded from such studies due to their relatively small size and poor preservation. Scheuer and Elkington (1993) were able to show that metacarpals and the first proximal phalanx are sexually dimorphic, with accuracies ranging from 78.0% - 92.0% and 74.0% - 78.0% respectively. The aim of this study was to determine sexing accuracies using the proximal (PP) and middle (MP) phalanges of the human hand in a South African sample. A total skeletal sample of 200 individuals (100 males and 100 females) was used. Seven measurements were recorded on each bone to an accuracy of 0.01mm. Data were analyzed using SPSS version 11.5. Statistically significant differences (p<0.01) were found between males and females for all variables. In the stepwise discriminant function analysis, the variables selected for proximal phalanges were the antero-posterior midshaft diameter for the first proximal phalanx, the medio-lateral midshaft measurement of the second and fifth proximal phalanges and the antero-posterior base diameter of the third and fourth proximal phalanges. Variables selected for the middle phalanges were the antero-posterior base diameter for the second middle phalanx and the medio-lateral midshaft measurement for the third, fourth and fifth middle phalanges. Classification accuracies for proximal phalanges using the stepwise analysis ranged between 80.6% and 84.0% (males) and 85.9% to 88.8% (females), with the highest accuracies obtained for PP1 (males and females) and PP3 (females). Direct analyses for proximal phalanges using single variables produced accuracies ranging from 74.5% to 85.0% (males) and 86.6% to 88.9% (females). Classification accuracies for middle phalanges using the stepwise analysis, ranged between 77.6% and 85.0% (males) and 85.4% to 86.7% (females), with the highest accuracies obtained for MP3. Direct analyses for middle phalanges using single variables produced accuracies ranging from 71.7% to 79.2% (males) and 83.3% to 85.4% (females). In conclusion, these results compare with those of previous studies indicating that these bones can be used to determine sexPoster presented at the University of Pretoria Health Sciences Faculty Day, August 2009, Pretoria, South Afric